本文由小咖机器人翻译整理

期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-1588

摘要内容如下：

背景

2014年里程碑评级系统的采用可能影响了对少数群体的评估偏见。

客观

评估内科（IM）住院医师知识评级对黑人或拉丁裔住院医师（在医学（Urim）中代表性不足）和亚裔住院医师在2014年里程碑采用之前和之后的偏见。

设计

横截面和间断时间序列比较。

设置

美国IM派驻服务。

参与者

在2008年至2013年和2015年至2020年期间，有59835名IM居民完成了住院实习。

干预

采用里程碑评级系统。

测量

里程碑前（2008年至2013年）和里程碑后（2015年至2020年）的偏差被估计为美国出生和非美国出生的少数族裔群体与非拉丁裔美国出生的白人（NLW）居民之间的标准化知识评级差异，并根据美国内科医学委员会IM认证考试的表现和其他医生特征进行调整。中断的时间序列分析测量了与里程碑前线性偏差趋势的偏差。

结果

在里程碑前阶段，对少数群体的评分偏差较大（-0.40 SDS[95%CI，-0.48 to-0.31 SDS；P<0.001]，Urim居民，-0.24 SDS[CI，-0.30至-0.18 SDS；P<0.001]，美国出生的亚裔居民为-0.36 SDS[CI，-0.45至-0.27 SDS；P<0.001]对于非美国出生的亚洲居民）。在对除美国出生的黑人居民外的所有群体采用里程碑评级后，这些估计值降至低于-0.15 SDS，在这些群体中，实质性（尽管较低）偏差持续存在（-0.26 SDS[CI，-0.36至-0.17 SDS；P<0.001]）。还观察到与采用里程碑评级一致的里程碑前线性偏差趋势的重大偏差。

局限性

未观察到的变量与评级偏差和里程碑评级采用、种族/民族识别的变化以及里程碑2.0的可推广性相关。

结论

随着里程碑评级系统的采用，对Urim和亚洲居民的知识评级偏见得到了改善。然而，对美国出生的黑人居民的严重评级偏见依然存在。

主要资金来源

没有。

英文原文如下：

Abstracts

BACKGROUND  The 2014 adoption of the Milestone ratings system may have affected evaluation bias against minoritized groups.

OBJECTIVE  To assess bias in internal medicine (IM) residency knowledge ratings against Black or Latino residents-who are underrepresented in medicine (URiM)-and Asian residents before versus after Milestone adoption in 2014.

DESIGN  Cross-sectional and interrupted time-series comparisons.

SETTING  U.S. IM residencies.

PARTICIPANTS  59 835 IM residents completing residencies during 2008 to 2013 and 2015 to 2020.

INTERVENTION  Adoption of the Milestone ratings system.

MEASUREMENTS  Pre-Milestone (2008 to 2013) and post-Milestone (2015 to 2020) bias was estimated as differences in standardized knowledge ratings between U.S.-born and non-U.S.-born minoritized groups versus non-Latino U.S.-born White (NLW) residents, with adjustment for performance on the American Board of Internal Medicine IM certification examination and other physician characteristics. Interrupted time-series analysis measured deviations from pre-Milestone linear bias trends.

RESULTS  During the pre-Milestone period, ratings biases against minoritized groups were large (-0.40 SDs [95% CI, -0.48 to -0.31 SDs; P < 0.001] for URiM residents, -0.24 SDs [CI, -0.30 to -0.18 SDs; P < 0.001] for U.S.-born Asian residents, and -0.36 SDs [CI, -0.45 to -0.27 SDs; P < 0.001] for non-U.S.-born Asian residents). These estimates decreased to less than -0.15 SDs after adoption of Milestone ratings for all groups except U.S.-born Black residents, among whom substantial (though lower) bias persisted (-0.26 SDs [CI, -0.36 to -0.17 SDs; P < 0.001]). Substantial deviations from pre-Milestone linear bias trends coincident with adoption of Milestone ratings were also observed.

LIMITATIONS  Unobserved variables correlated with ratings bias and Milestone ratings adoption, changes in identification of race/ethnicity, and generalizability to Milestones 2.0.

CONCLUSION  Knowledge ratings bias against URiM and Asian residents was ameliorated with the adoption of the Milestone ratings system. However, substantial ratings bias against U.S.-born Black residents persisted.

PRIMARY FUNDING SOURCE  None.

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